Anxiety disorders Post-traumatic stress disorder, alexithymia and somatoform dissociation in patients with fibromyalgia

Objective: Fibromyalgia (FM) is a common disorder that is associated with a high rate of psychiatric co-morbidity (depression, anxiety disorders), its association with post-traumatic stress disorder (PTSD), alexithymia and dissociative symptoms has not been sufficiently investigated. The present study evaluated three hypotheses: 1- That a high frequency of traumatic experiences and PTSD would be observed in patients with FM. 2- That FM would be associated with symptoms of alexithymia and somatoform dissociation. 3- That trauma negatively affects the clinical parameters of FM.

Methods: Fifty-six consecutive patients with FM admitted to the outpatient department were enrolled in this study after providing informed consent. Forty-six patients with rheumatoid arthritis (RA) were enrolled as controls. Participants completed the Somatoform Dissociation Questionnaire (SDQ), the Post-traumatic Diagnostic Scale (PDS), the Toronto Alexithymia Scale (TAS), and The Childhood Trauma Questionnaire (CTQ). The impact of FM was measured with the Fibromyalgia Impact Questionnaire (FIQ).

Results: The number of patients reporting at least one traumatic event was higher in the FM (19, 33.9%) than in the RA (6, 13%) (x2= 5.9, p= 0.015) group. Post-traumatic stress disorder (PTSD) was found in six (10.7%) out of 56 subjects with FM. In the RA group, no patients met the criteria for PTSD. Current PTSD prevalence was higher in the FM than in the RA group. Among those with FM group and traumatic experiences, FIQ scores were higher in patients with than without PTSD (p= 0.02). FM patients had significantly higher scores than did RA patients on the CTQ, SDQ and TAS.

Conclusion: PTSD, alexithymia, and somatoform dissociative symptoms are common in FM patients. It is important to identify and treat PTSD, alexithymia, and dissociative symptoms in FM patients as these can affect the patients’ health. Taken together, results from previous studies with adults and those from the present study suggest that treatment of PTSD, alexithymia and dissociative symptoms positively inşuences the levels of pain and FM-related disability in FM patients. Our findings support the idea that trauma-oriented approaches are important in the treatment of FM.